Individual
GERALD NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2571
(214) 343-6663
(214) 343-2814
Mailing address
1121 E SPRING CREEK PKWY, STE. 110, #319, PLANO, TX 75074
(214) 343-6663
(214) 343-2814
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
K6194
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040275201
—
TX
01
—
K6194
LICENSE
TX
Enumeration date
04/04/2006
Last updated
08/25/2024
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